In the EMS profession , every prospective EMT and paramedic student is taught how to react to and handle an incident involving multiple casualties . They know once they are out on their own in the field , it can happen and will happen , anyday , anytime , and being prepared is essential . when something like that happens there is no time to be standing around gawking , with the OMG look on one's face . It's time for quick decisive action , organization and importantly teamwork to treat and stabilize the victims then transport them to an appropriate hospital as rapidly as possible .

My first Multi Casualty Incident came in the summer of 1982 . It was an unusually slow day with just a couple of non-emergency transports to answer for and most of us at Magic Valley Ambulance were being idle . We were sitting around the office talking telli ng stories and bad jokes . reading , watching t.v. ( damn thing only worked half the time anyway ) , or studying . I was sitting on the couch under the speaker for the police scanner in our office , reading the latest edition of Emergency magazine when county law enforcement dispatch had sent deputies to a two vehicle , head on collision on a country road about 1 mile south and a quarter mile west from the east end of town . according to dispatch , there were multiple injuries , traffic blockage , and extrication was required . No sooner then I got up to warn the rest of the guys that were about to get a call , the emergency line rang and the tones went off for our competitors on another frequency . The boss sent four of my co-workers and two ambulances to the scene while my other boss , two other co-workers and myself suited up and rolled out to the scene in our 1970 Chevy four wheel drive low roof Suburban ambulance that was our off road and extrication rig . It was white with a red stripe down the sides , hood , and back end with the star of life stickers on the rear doors . It had a Federal Model 184 roof beacon , Federal PA 15 siren , a Motorola Motrac UHF radio to law enforcement agencies , another one on VHF HI Band to the hospital , and a third radio to contact the US Forest Service & Bureau of Land Management police units on their frequencies .

When we arrived on scene , it looked like one chaotic mess . The victims moaning & writhing in pain , begging for help , emergency vehicles everywhere , and those who witnessed the accident . I didn't feel intimidated in any way but knew well enough there was a lot of work to be done and very little time to do it . We knew that a passenger car and a pickup truck had collided head on , passengers were all unrestrained , and both vehicles had major front end damage with the front seat passengers pinned in by the dash board unable to get out . There was a low risk of fire to the vehicles and the speed limit on that stretch of road was 50 miles per hour . We also knew that there was a potential for major traumatic injury or fatalities .

We also knew that we had a total of seven patients , five in the car and two in the pickup truck , but we had to decide immediately which vehicle to start extrication with first factoring in the mechanism of injury , time of the accident , extent of injuries , and any immediate hazards . Our group decided to take on the pickup truck because we had a female patient that was nine months pregnant and en route to the hospital with her boyfriend /husband to give birth to her first born child ! She had abdominal injuries , cuts and lacerations to her forehead and face , and a broken ankle or foot but due to her pregnancy we classified her as a critical patient . We were deeply concerned about her because of the danger of her possibly losing her unborn child as well as her own life . Meanwhile , her companion had a broken leg , face , forehead & scalp lacerations , back pain , and bruising on his chest with no broken bones or signs of pneumothorax .

A local fire department who was then relied on for backup vehicle extrication arrived on scene to take care of and free the victims trapped in the car .

Extrication was started on the pickup truck and we spent no time getting rid of the roof so my co-workers could go to work on assessing and stabilizing both patients . As soon as we raised the dashboard off the victims and removed the doors we could get them immobilized on backboards and transport to the hospital ER .

Now , take in mind that 35 years ago in our area of Idaho , we didn't have the luxuries of having a trauma center setup in our ER , paramedics , or a medical helicopter . This meant that if a patient needed specialized medical care , they would have to go by ground ambulance to hospitals in Boise or Salt Lake City . The highest level of training allowed at the time was Advanced EMT at the Intermediate Life Support ( ILS ) level . In addition to the skills roles and responsibilities a Basic EMT learns , they had at the time additional hours of training and education in administering I.V. fluids , Esophageal Obturator Airway ( EOA ) insertion , and application of the Pneumatic Anti Shock Garment (PASG ) or " MAST " suit . There were eight people certified at that level at the service that I worked for and the other service had 10 .

Moments later , as we were loading our patients into our 1981 Chevy Type ll hi roof van ambulance , my boss came over to ask who was going to drive to the hospital . I had a driver's licence with a good driving record so I excepted the assignment .

The unit itself was your basic orange & white rig with a Federal light bar with red and clear bulbs and clear lenses . it had two steady burning red lights on the hood with red flashing lights on the rear and sides with two white alley lights on each side . There was also two sirens in it . An SVP ( Southern Vehicle Products ) and North American Signal push button electronic . The police and hospital radios were both Motorola Micors . It had a 350 cc V-8 gas engine under it's hood .

I then hopped inside the front seat , fastened my seat belt , shut the door and started moving Code 3 to the hospital while notifying our dispatch . an ambulance from the other service along with a sheriff's deputy fell in behind me . NOw , all my attention was focused on getting these two patients and three of my fellow co-workers to the hospital as fast and safely as I can in one piece without heaven forbid having an accident . My mind was also focused on the traffic ahead and around us and there were no problems getting to the hospital . People were actually pulling over for us !

In a span of just about five minutes , we arrived at the new ER that had just opened up as part of an extensive renovation and expansion project . The ER staff was standing at the ready for the hand off of the patients coming in and we were directed to put the pregnant woman's significant other in the orthopedic treatment room and her in one of the resuscitation rooms . The others coming in would be placed in any one of the yellow curtained treatment stalls except for the driver of the car who was also critical , going into the other resuscitation room . The driver of the car had some extensive orthopedic injuries with a suspected concussion , so he was later that evening transferred to a hospital in Boise , that had the facilities to surgically treat his injuries .

Another one of the patients was hospitalized overnight for observation and three of them were treated and later released .

After we got the Patient Care Report ( PCR ) paperwork done and got the ambulance cleaned up , put back together and placed back into service , we headed back to the office concerned about the pregnant woman and exhausted .

It wasn't a bit over an hour later with all of us back from the call , when the elder boss who was also the county Coroner walked into the lobby with a saddened look on on his face . He called us all in there to break the bad news to us that he just got a call from the ER doc , and that in fact the baby had died . Our hearts were all broken and there were no words spoken , just stunned looks and tears shed . But if there is anything good to come out of this senseless tragedy , both our service and the new one worked well together without any bickering or a pi**ing contest .

However for myself , even though this is one call that I really want to forget about , I guess I never will .